Alessandra Baccaro1, Yuan-Pang Wang2, Miriam Candido3, Adriana Bastos Conforto4, André Russowsky Brunoni5, Claudia da Costa Leite6, Geraldo Busatto Filho7, Paulo A Lotufo8, Isabela M Benseñor8, Alessandra Carvalho Goulart9. 1. Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Laboratory of Psychiatric Neuroimaging (LIM21), Departamento de Psiquiatria, Universidade de Sao Paulo, Medical School, Brazil. Electronic address: alessandra@baccaro.eu. 2. Institute of Psychiatry, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil; Laboratory of Medical Investigations of Psychopharmacology and Clinical Psychophysiology (LIM23), Universidade de Sao Paulo, Medical School, Brazil. 3. Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil. 4. Department of Neurology, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil. 5. Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Institute of Psychiatry, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil. 6. Medical School, Universidade de Sao Paulo, Brazil; Nucleo de Apoio a Pesquisa em Neurociencia Aplicada (NAPNA), Universidade de Sao Paulo, Brazil; Institute of Radiology and Oncology, Hospital das Clinicas, Universidade de Sao Paulo, Brazil. 7. Laboratory of Psychiatric Neuroimaging (LIM21), Departamento de Psiquiatria, Universidade de Sao Paulo, Medical School, Brazil; Institute of Psychiatry, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil; Medical School, Universidade de Sao Paulo, Brazil; Nucleo de Apoio a Pesquisa em Neurociencia Aplicada (NAPNA), Universidade de Sao Paulo, Brazil. 8. Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Medical School, Universidade de Sao Paulo, Brazil. 9. Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil. Electronic address: agoulart@hu.usp.br.
Abstract
BACKGROUND: Post-stroke depression (PSD) and cognitive impairment (PCI) are common conditions. This study aims to describe the protocol and preliminary findings of an investigation into factors associated with PSD and PCI 1-3 months after stroke (subacute phase) in survivors from the Study of Stroke Mortality and Morbidity (EMMA study). METHODS: Stroke patients underwent to clinical and neurological evaluations on admission to hospital. Cerebral magnetic resonance and biomarkers (serotonin, BDNF, IL-6 and IL-18) were carried out in the subacute phase. DSM-IV major depression for the diagnosis of PSD, cognitive functioning for the diagnosis of PCI and functional disability were also recorded at same time. RESULTS: Of the 103 eligible patients, 85.4% had ischemic stroke and 73.7% had first-ever stroke. In the subacute phase, 27.2% had PCI and 13.6% had current PSD (5.8% with 'first episode' and 7.8% with 'recurrent' depression). PCI was associated with low education (0-7 years of formal education: 75%) and ageing (median age: 70; interquartile range: 59-75 y-old). Left-sided stroke was more frequently associated with increased PCI than right-sided stroke (71.4% vs. 28.4%, p = 0.005). PSD was neither associated with stroke laterality nor tentorial area. Overall, biomarkers levels were not alterated in patients with PSD and PCI. LIMITATIONS: Findings are based on small sample and less disabled stroke participants, e.g. those without aphasia and deafness. CONCLUSIONS: Findings reinforce the need of early recognition and rehabilitation of PCI and PSD, mainly among those less educated and with left-sided stroke. PSD might occur through a pathophysiological pathway other than classical depression.
BACKGROUND: Post-stroke depression (PSD) and cognitive impairment (PCI) are common conditions. This study aims to describe the protocol and preliminary findings of an investigation into factors associated with PSD and PCI 1-3 months after stroke (subacute phase) in survivors from the Study of Stroke Mortality and Morbidity (EMMA study). METHODS:Strokepatients underwent to clinical and neurological evaluations on admission to hospital. Cerebral magnetic resonance and biomarkers (serotonin, BDNF, IL-6 and IL-18) were carried out in the subacute phase. DSM-IV major depression for the diagnosis of PSD, cognitive functioning for the diagnosis of PCI and functional disability were also recorded at same time. RESULTS: Of the 103 eligible patients, 85.4% had ischemic stroke and 73.7% had first-ever stroke. In the subacute phase, 27.2% had PCI and 13.6% had current PSD (5.8% with 'first episode' and 7.8% with 'recurrent' depression). PCI was associated with low education (0-7 years of formal education: 75%) and ageing (median age: 70; interquartile range: 59-75 y-old). Left-sided stroke was more frequently associated with increased PCI than right-sided stroke (71.4% vs. 28.4%, p = 0.005). PSD was neither associated with stroke laterality nor tentorial area. Overall, biomarkers levels were not alterated in patients with PSD and PCI. LIMITATIONS: Findings are based on small sample and less disabled strokeparticipants, e.g. those without aphasia and deafness. CONCLUSIONS: Findings reinforce the need of early recognition and rehabilitation of PCI and PSD, mainly among those less educated and with left-sided stroke. PSD might occur through a pathophysiological pathway other than classical depression.
Authors: Yeong Hwan Ryu; Seo Young Kim; Tae Uk Kim; Seong Jae Lee; Soo Jun Park; Ho-Youl Jung; Jung Keun Hyun Journal: J Clin Med Date: 2022-04-18 Impact factor: 4.964